title: Evaluation of the anatomical site distribution of chlamydia and gonorrhoea in men who have sex with men and in high-risk women by routine testing: cross-sectional study revealing missed opportunities for treatment strategies.
abstract: OBJECTIVE
  Current strategies for controlling non-urogenital chlamydia and gonorrhoea are not uniform. It is assumed that present anorectal/oropharyngeal infections are coincidentally treated with urogenital infections. However, it is not clear whether this control strategy is effective. To inform current debate, we evaluated the anatomical site distribution of chlamydia and gonorrhoea by routine testing in men who have sex with men (hereafter men) and in high-risk women (prostitutes and swingers, hereafter women).
  
  
  METHODS
  Between January 2010 and November 2012, all men (n=2436) and women (n=1321) attending our sexually transmitted infection clinic were routinely tested for anorectal, oropharyngeal and urogenital Chlamydia trachomatis and Neisseria gonorrhoeae. Data were collected on demographics and sexual behaviour.
  
  
  RESULTS
  Overall chlamydia positivity was 10.4% (254/2436) in men and 7.0% (92/1321) in women, for gonorrhoea this was 6.3% (154/2436) and 3.1% (41/1321), respectively. Isolated non-urogenital infections amounted to 76% of all infections in men and for up to 59% of all infections in women. For combined urogenital and anorectal infections, this amounted to 14% for men and up to 54% for women.
  
  
  CONCLUSIONS
  Testing only for non-urogenital infections is insufficient, as it overlooks many infections. The use of coincidental treatment is therefore a suboptimal control strategy in high-risk groups for halting complications and transmission. There is an urgent need to optimise the testing guidelines for chlamydia and gonorrhoea at different anatomical sites.
authors.affiliation: Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, , Geleen, Netherlands.
authors.forename: Geneviève A F S
authors.initials: GA
authors.lastname: van Liere
authors.forename: Christian J P A
authors.initials: CJ
authors.lastname: Hoebe
authors.forename: Nicole H T M
authors.initials: NH
authors.lastname: Dukers-Muijrers
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D003430:Cross-Sectional Studies; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D009426:Netherlands / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D015995:Prevalence; D060386:Sex Workers; D012725:Sexual Behavior / Q000502:physiology*
keywords: CHLAMYDIA TRACHOMATIS; EPIDEMIOLOGY (GENERAL); NEISSERIA GONORRHOEA; PUBLIC HEALTH; TESTING